Blue - BlueEssentials Silver 12

South Carolina, 2017

  • Plan Type

    EPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $4,800

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $4,800
Deductible (Family) $9,600
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $3,000
Deductible (Family) $6,000
Out of Pocket Maximum (Individual) $5,450
Out of Pocket Maximum (Family) $10,900

Doctor Visits

Primary Care Physician
Specialists 30% Coinsurance after deductible
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $2,250
Out of Pocket Maximum (Family) $4,500

Doctor Visits

Primary Care Physician
Specialists 20% Coinsurance after deductible
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $150
Deductible (Family) $300
Out of Pocket Maximum (Individual) $2,250
Out of Pocket Maximum (Family) $4,500

Doctor Visits

Primary Care Physician
Specialists 5% Coinsurance after deductible
Emergency Room 5% Coinsurance after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in South Carolina

Plan BlueEssentials Catastrophic 1 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 2 Deductible $6,300 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials HD Silver 6 Deductible $3,800 Coinsurance Not applicable Out of Pocket $3,800
Plan BlueEssentials Silver 9 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,850
Plan BlueEssentials Silver 14 Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 8 Deductible $5,250 Coinsurance Not applicable Out of Pocket $6,700
Plan BlueEssentials HD Silver 13 Deductible $4,400 Coinsurance Not applicable Out of Pocket $4,400
Plan BlueEssentials HD Silver 5 Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,000
Plan Blue Cross Blue Shield Silver 1, a Multi-State Plan Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Gold 2 Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan BlueEssentials Gold 1 Deductible $1,200 Coinsurance Not applicable Out of Pocket $4,500
Plan BlueEssentials Silver 2 Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Silver 10 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Bronze 1 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 3 Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 4 Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 5 Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 7 Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Gold 4 Deductible $2,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BlueEssentials HD Gold 3 Deductible $2,200 Coinsurance Not applicable Out of Pocket $2,200
Plan BlueEssentials HD Bronze 4 Deductible $5,600 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Gold 1, a Multi-State Plan Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan BlueEssentials Silver 3 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan BlueEssentials Silver 11 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 1 Deductible $260 Coinsurance Not applicable Out of Pocket $7,150
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $4,800
Deductible (Family) $9,600
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Not available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $3,000
Deductible (Family) $6,000
Out of Pocket Maximum (Individual) $5,450
Out of Pocket Maximum (Family) $10,900

Doctor Visits

Primary Care Physician
Specialists 30% Coinsurance after deductible
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $2,250
Out of Pocket Maximum (Family) $4,500

Doctor Visits

Primary Care Physician
Specialists 20% Coinsurance after deductible
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $150
Deductible (Family) $300
Out of Pocket Maximum (Individual) $2,250
Out of Pocket Maximum (Family) $4,500

Doctor Visits

Primary Care Physician
Specialists 5% Coinsurance after deductible
Emergency Room 5% Coinsurance after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in South Carolina

Plan BlueEssentials Catastrophic 1 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 2 Deductible $6,300 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials HD Silver 6 Deductible $3,800 Coinsurance Not applicable Out of Pocket $3,800
Plan BlueEssentials Silver 9 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,850
Plan BlueEssentials Silver 14 Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 8 Deductible $5,250 Coinsurance Not applicable Out of Pocket $6,700
Plan BlueEssentials HD Silver 13 Deductible $4,400 Coinsurance Not applicable Out of Pocket $4,400
Plan BlueEssentials HD Silver 5 Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,000
Plan Blue Cross Blue Shield Silver 1, a Multi-State Plan Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Gold 2 Deductible $800 Coinsurance Not applicable Out of Pocket $5,000
Plan BlueEssentials Gold 1 Deductible $1,200 Coinsurance Not applicable Out of Pocket $4,500
Plan BlueEssentials Silver 2 Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,600
Plan BlueEssentials Silver 10 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Bronze 1 Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 3 Deductible $5,200 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 4 Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials HD Bronze 5 Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan BlueEssentials Silver 7 Deductible $6,400 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Gold 4 Deductible $2,200 Coinsurance Not applicable Out of Pocket $5,000
Plan BlueEssentials HD Gold 3 Deductible $2,200 Coinsurance Not applicable Out of Pocket $2,200
Plan BlueEssentials HD Bronze 4 Deductible $5,600 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross Blue Shield Gold 1, a Multi-State Plan Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan BlueEssentials Silver 3 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan BlueEssentials Silver 11 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,150
Plan BlueEssentials Silver 1 Deductible $260 Coinsurance Not applicable Out of Pocket $7,150